ABSTRACT Objectives This ASPO survey investigates pediatric peri‐operative tracheostomy care practices through a nationwide survey. It aims to identify challenges, explore opportunities for standardization across institutions, and recommend strategies that could reduce complications and enhance patient care. Methods A 19‐question survey was administered online to pediatric otolaryngologists. Descriptive statistics summarized respondent demographics and responses. Results Of 138 respondents, 90% practiced in the US, primarily in the Mid‐Atlantic and Great Lakes. Over 60% performed fewer than 10 pediatric tracheostomies annually. A majority (98%) used stay sutures for accidental decannulation, and 25% did not mature the stoma. Notably, 92% adhered to standardized post‐operative protocols. Bivona tracheostomy tubes were most commonly used (72%). First tube changes were typically on postoperative Days 5 and 7, with false passage creation (46%) and bleeding (41%) as primary complications. Routine surveillance bronchoscopy was conducted by 63%, mainly twice in the first year (34%). Conclusion The survey highlights wide variation in pediatric tracheostomy practices and underscores the importance of standardized protocols. Most respondents perform fewer than 10 procedures each year, yet adherence to institutional guidelines reflects a strong commitment to safety. This study identifies key areas of variability such as the timing of the first tube change, use of surveillance bronchoscopy, and reported complications—and outlines opportunities for further research and standardization aimed at improving consistency and clinical outcomes. Level of Evidence 5.